Failure to Check Gastric Residual Before G-Tube Medication Administration
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) failed to check the gastric residual volume before administering medications via a gastrostomy tube (g-tube) to a female resident with severe cognitive impairment and a history of gastrostomy. The resident's care plan and physician orders specifically required that gastric residuals be checked every shift and prior to medication administration to prevent complications such as aspiration. During direct observation, the LVN prepared and administered the resident's medications through the g-tube without performing the required residual check, despite having the necessary supplies and knowledge of the correct procedure. The resident's medical record indicated a significant risk for aspiration related to the g-tube, and the care plan included interventions to check gastric residuals as a preventive measure. Interviews with the LVN and facility leadership confirmed that the expected protocol was not followed, and the LVN acknowledged forgetting to perform the check due to nervousness. The facility's policy also mandated residual checks to prevent complications for residents with enteral feeding tubes.